The entire world — public and private alike — is teeming with health tips. Whether you like it or not, you are always getting advice from qualified and unqualified sources on how to stay healthy and fit, how to avoid the diseases that afflict and kill the majority of highly civilized people, and what to do to prevent or manage the most common ailments. It is evidently taken for granted — or at least goes unchallenged — that many maladies, and especially the most widespread ones, are a matter of lifestyle, of how people deal with the circumstances of their lives. And somehow all these well-intentioned and practical pointers explicitly or implicitly assume that there must be something amiss with these “circumstances” themselves if people have to navigate them so carefully and skillfully to preserve their health.

It is in fact no secret that the anything-but-natural conditions determining an average bourgeois life are more or less the cause of most of the ailments that torment and ultimately kill people nowadays. The link between cause and effect even has a name: what were once plague and epidemics are today known as diseases of civilization. After defining them — ailments “whose incidence is very probably linked with the lifestyle habits or living conditions prevailing in industrialized countries” — medical experts immediately deny this in a way:

“The term ‘disease of civilization’ is misleading in that improved social and economic infrastructure does not automatically entail disease but — on the contrary — signifies an improvement in medical care. Diseases of civilization are caused not by civilization itself, but by an unhealthy lifestyle not appropriate to human physiology…” (flexikon.doccheck.com)

But what good does it do to point out with the best intentions that “infrastructure” does “not automatically” cause illness, that there must still be someone who actually has an “unhealthy lifestyle”? If the corresponding “lifestyle” shows such a high “incidence,” and its health consequences are so “probably linked with the lifestyle habits or living conditions” in “industrialized countries,” then that lifestyle is bound to fit in with those conditions. And in the end it is actually not that important what style people find for dealing with the circumstances of their existence — they don’t seem to end up being particularly individualistic about it anyway. What matters is what people have to cope with day in and day out in their stylish way of life.

In any case, one thing is certain, and properly ascertained by statistics: there are not that many ailments that typically afflict and kill the majority of industrialized, affluent citizens in the civilized world:

”A relatively small group of health conditions is responsible for a large part of the disease burden in Europe. Of the six WHO regions, the European Region is the most affected by noncommunicable diseases (NCDs), and their growth is startling. The impact of the major NCDs (diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders) is equally alarming: taken together, these five conditions ac­­count for an estimated 86% of the deaths and 77% of the disease burden in the Region“ (www.euro.who.int).

This finding is likely neither a coincidence nor the result of a collective decision to behave foolishly all the time under living conditions that are actually quite benign. It points to pressures, very stereotypical ones in fact, that these civilized circumstances impose on their inhabitants, that they themselves are determined to cope with on the basis of an equally stereotypical lifestyle — and that are evidently impossible to take in the long run. Which pressures and which ways of coping are involved — this is sometimes easy to see in the resulting pathologies, and sometimes it is not. All in all, these “modern plagues” speak clearly enough for themselves — or so one would think.

1. Modern clinical conditions

When it comes to the most popular causes of death, the undefeated winner for decades has been cardiovascular disease. To be sure, medicine has a lot under control in this area, with cardiac catheterization now a routine procedure for cardiologists, plenty of bypasses, stents and shunts being implanted, and — as studies say — some low-salt diets allegedly preventing high blood pressure. Nevertheless, cardiovascular disease remains “currently responsible for forty-one percent of all deaths in Germany, according to the Federal Statistical Office — and thus the leading cause of death by a wide margin” (H. Greten, Innere Medizin [Internal Medicine], 2010, p. 253).

The basis for this is a highly unwholesome way of putting the heart and circulatory system under strain. Exertion — whether physical or psychological — requires the circulatory system to increase its pumping capacity, which it promptly does by increasing heart rate and contracting the heart muscle more forcefully. The result of all this is elevated blood pressure, which in itself is not a problem provided it drops through sufficient relaxation. However, if the excitation and the resulting rise in blood pressure persist, the peripheral blood vessels themselves react by constricting and thickening; this eventually “locks in” the high blood pressure, making it irreversible, regardless of the actual level of exertion. The development of hypertension thus indicates that an exertion has been sustained until it transitioned into a state of overload, causing the tension to manifest physically as a disease. Standard medical texts describe this phenomenon as follows:

“Hypertension thus arises from an increase in cardiac output (CO) or total peripheral resistance (TPR), or both…The increase in CO seen in hyperdynamic hypertension results from either an elevated heart rate or … an increased stroke volume … An increase in sympathetic activity originating in the central nervous system … [can] also cause CO to rise … Vasoconstriction occurs in response to increased sympathetic activity … Autoregulatory processes also involve vasoconstriction. For instance, if blood pressure rises due to an increase in CO, many organs (e.g., the kidneys, the gastrointestinal tract) ‘protect’ themselves against this high pressure. This contributes to the common vasoconstrictive component of hyperdynamic hypertension, causing it to transition into resistance-type hypertension. Hypertrophy of the vasoconstrictive musculature also plays a role in this process. Finally, the high blood pressure results in vascular damage, further increasing TPR (locking in the hypertension)” (W. Siegenthaler; Klinische Pathophysiologie [Clinical Pathophysiology], 2006, p. 222).

At this point and as a result, the person becomes a patient with hypertension in whom sustained elevated blood pressure in the whole body leads to “clinical sequelae such as coronary heart disease (CHD, angina pectoris, myocardial infarction, sudden cardiac death), cerebrovascular insufficiency (stroke), and peripheral arterial occlusive disease” (H. Greten; ibid., p. 40).

“After cardiovascular disease, malignant diseases are the second most common cause of death in the Western world… Almost every second person now develops cancer, and every fourth to fifth citizen dies from this disease.” (W. Siegenthaler, ibid., p. 1101)

While cancers manifest in widely varying ways depending on the type of malignant tissue involved, most share a common origin: carcinogens damage the cell’s genetic information — ultimately in an irreversible way. And the list of known carcinogens to which the general population in a thriving industrial nation like ours is exposed year in and year out tends to grow longer rather than shorter from year to year. Cancer arises when a DNA mutation causes an irreversible disruption of cell-cycle regulation, causing a cell to become malignant, that is, to keep dividing incessantly. “Both the intensity and the duration of the damage leading to malignant transformation play a role in this process” (H. Greten, ibid., pp. 953 f.). Since cells possess numerous regulatory and repair mechanisms encoded in their genetic information, which prevent mutations from being passed on to daughter cells even and especially when they are damaged, multiple mutations generally have to accumulate before tissue can become malignant; at that point, the damage can no longer be remedied even through regulated death of the individual cell.^[1]

“Up to twenty percent of the German population (a figure that is rising) suffer from allergies… This puts allergies among the most common diseases in countries with a high standard of living” (this and the following quotes are from H. Greten, ibid., pp. 1082 ff.).

An allergy develops when an organism shows an excessive immune response to a single substance or range of substances from the natural world or the civilized world, known as allergens, because it cannot (any longer) take the burden they impose, causing a change in its “immunological responsiveness”:

“Allergy: an individual alteration in immunological responsiveness manifesting as an excessive, pathogenic immune response (hyperreactivity) to foreign antigens (allergens).”

Even though allergens are “non-pathogenic under physiological immune conditions, that is, would not cause harm on their own,” this does not alter the fact that it is these “foreign” (i.e., external) substances themselves that, sooner or later in this or that organism, “sensitize” (that is, burden) the immune system to such an extent that it reacts with overload, that is, an allergy. The prevalence of allergies in industrialized nations is due to the “ubiquitous presence of immediate-type allergens… Latex products alone, through their use in medicine… have already caused sensitization in over ten percent of personnel.” Which is why it is conversely true that “avoiding the causative allergen leads to an improvement or complete disappearance of symptoms.” If the “causative allergen” is not avoided, for whatever reason, the immune reaction becomes self-perpetuating, the inflammatory processes become chronic and do not readily heal even when the allergen is totally avoided.

“Due to chronic inflammatory processes, primarily as a result of recurrent allergen exposure, the mucous membranes develop a nonspecific hypersensitivity… which resolves only after months even when the allergen is totally avoided. In such cases it is difficult to identify the causative allergen.”

Type 2 diabetes “is one of the most widespread diseases in Germany, affecting around six million patients and — presumably — just as many people with undiagnosed diabetes or at high risk of developing this metabolic disorder” (www.dzd-ev.de).

It is caused by constantly elevated blood-sugar and blood-fat levels that are usually caused by overeating, but stress also increases these levels. “The imbalance between energy intake and energy expenditure increases the concentration of fatty acids in the blood, which in turn reduces glucose utilization in muscle cells and fat cells” (S. Silbernagl, ibid., p. 308).

The hormone insulin is released when blood sugar levels rise after food intake; it normally binds to cell membranes — primarily those of muscle cells — triggering the uptake of sugar from the blood into the cells, where it becomes available for producing energy. When energy intake is constantly elevated, cells become increasingly resistant to insulin and no longer respond adequately to the hormone by taking up sugar; consequently, blood sugar levels remain elevated. This effect is compounded by low energy expenditure in muscle cells. In response, the body’s hormonal regulatory system increases insulin secretion, which usually lowers blood sugar levels sufficiently but simultaneously exacerbates cellular insensitivity to insulin. A qualitative and problematic shift occurs when the metabolism is chronically confronted with an oversupply of glucose — and/or responds to stress by constantly mobilizing stored sugar — to the point where increased insulin secretion can no longer compensate for the reduced insulin efficacy. Blood glucose concentrations then remain persistently high, causing damage to the organism in various places. In the worst-case scenario, insulin production in the pancreas fails completely.

"After manifestation of the disease, all forms of diabetes mellitus are associated with both a secretion disorder and insulin resistance. The resulting hyperglycemia exacerbates this disorder and, if left untreated, leads to glucose toxicity, which triggers a vicious circle… The first indications of insulin resistance can be found many years before diabetes manifests. However, as long as insulin resistance can be compensated for by increased insulin secretion, it is probably without clinical significance. Only when hyperinsulinemia can no longer be sustained due to a limited capacity for synthesis and secretion do blood glucose levels rise, leading to the onset of type 2 diabetes" (W. Siegenthaler; ibid., p. 83).

If the disease cannot be successfully “managed” with medication, it leads to secondary complications such as heart attack, stroke, severe circulatory and wound-healing disorders, blindness, and kidney failure.

Perennial favorite among modern mass diseases are musculoskeletal disorders.

“One in three people who consult an orthopedist… does so because of back pain… Many of those plagued by nonspecific back pain belong to the comparatively young age group of 30- to 50-year-olds — people who are in the prime of their working lives” (this quote and the following one are from www.apotheken-umschau.de).

The ‘back trouble’ the population so widely suffers from is “usually a result of constant overexertion or neglect of the back. This can be explained by a key principle of muscle function: the interplay between agonist and antagonist muscles or corresponding muscle groups. When strenuous exertion overtaxes specific agonist or antagonist muscles, or inactivity causes them to atrophy, the result is tension, overstretching, shortening, and ultimately pain.”

Depending on how robust an individual’s joints are and how much compensatory exercise is done, joint damage will therefore occur sooner or later.

Chronic respiratory diseases are likewise widespread. Anyone who endures chronic irritation of the airways long enough — “the symptoms develop slowly over months or years” — runs a high risk of getting incurable bronchitis. When the bronchial mucosa is constantly exposed to dust, pollutants, or irritants, it suffers irreversible damage; continued exposure leads to chronic inflammation of the bronchi, resulting in the destruction of lung tissue, so that the lungs can no longer perform gas exchange and proper breathing becomes impossible:

“Chronic irritation of the airways leads to remodeling processes involving the proliferation of serous and mucous glands and the destruction of normal mucosal architecture. The cilia beating toward the mouth are progressively destroyed and subsequently unable to actively transport mucus. For the patient with severe chronic bronchitis, the cough reflex is then the only effective clearance mechanism. Contraction of the bronchial musculature and inflammatory infiltration of the bronchial mucosa… lead to chronic bronchial narrowing, the formation of bronchiectasis, and airway instability. Furthermore, chronic inflammation results in an imbalance between proteases… and antiproteases…, consequently leading to destruction of the terminal airways and alveolar septa. The result is pulmonary emphysema” (H. Greten, ibid., pp. 428 f.).

An increasing number of people suffer from mental and psychosomatic disorders:

“The Federal Chamber of Psychotherapists (BPtK) has… determined that the number of sick leave certifications citing the additional category of burnout (Z73 in ICD-10-GM) has risen by nearly 700 percent since 2004. In 85 percent of these cases, the physician also diagnosed a mental or physical illness” (Deutsches Ärzteblatt 2012; 109(24)).

Medicine is well aware of where these come from, and not just in the case of burnout, with its name already giving the answer:

“Thus, chronic overload and stress… have led to mental and psychosomatic illnesses such as depression, anxiety disorders, back pain, tinnitus, or cardiovascular disease” (Deutsches Ärzteblatt, ibid.).^[2]

Mental strain, feeling overwhelmed, anxiety, stress, agitation — conflicts that are unresolved for whatever reason can wear people down, even without causing physical damage. People become unable to do anything useful with themselves and the world — potentially even becoming unfit for work, which is the ultimate disaster in this society. Very often, however, a “disturbed” state of mind also affects the body: strains and the constant attempts to cope with them activate the autonomic nervous system, thereby interfering with the regulation of most organs. If this persists and the body cannot compensate for the physiological consequences, the chronic activation of the autonomic nervous system manifests as various illnesses. Sometimes a pre-existing organ defect can be exacerbated or an entirely new, independent disease can arise.

“These diseases include: coronary heart disease and its sequelae, essential hypertension, bronchial asthma, gastric and duodenal ulcers, chronic inflammatory bowel diseases (ulcerative colitis, Crohn’s disease), rheumatoid arthritis, fibromyalgia syndrome, atopic eczema, and numerous other conditions” (P. L. Janssen, Leitfaden psychosomatische Medizin und Psychotherapie [Guide to Psychosomatic Medicine and Psychotherapy], 2012, p. 39).

The physiological consequences, of course, do not show whether people are suffering from delusions or from genuine strains that they cannot get rid of — whether because they truly have no control over them or because from the start they have directed their dissatisfaction not at the things and circumstances that bother them, but at themselves. Such cases are medically diagnosed as “imbalance caused by chronic stress”:

"From a psychopathological perspective, physical illnesses involving organ destruction in which psychosocial factors play a contributory role do not constitute a uniform group. However, there is a body of clinical and empirical evidence supporting the assumption that, across the various diseases, there exists an imbalance in autonomic organ innervation caused by chronic stress, accompanied by corresponding neuroendocrinological and neuroimmunological abnormalities…" (P. L. Janssen, ibid., p. 39).

A person who defies the most popular causes of death by surviving for decades with the modern plagues has excellent chances of developing one of the many forms of dementia in old age:

“Risk factors for dementia: age, female gender, low body weight in female patients, dementia in relatives, prior head injury, low level of education, early-stage dementia, certain neurological or genetic disorders, prior stroke, risky alcohol consumption and alcohol dependence, vascular risk profile (e.g., arterial hypertension, hypercholesterolemia, nicotine abuse, diabetes mellitus, etc.)” (DEGAM-Leitlinie Demenz [German Society of Family Medicine’s Guideline on Dementia], 2008, p. 21).

Leaving aside for the moment the professional feat of abstraction by which the most disparate elements are gathered together under the umbrella term “risk factors” (more on that below), the “guidelines” make it abundantly clear that dementia, too, is not so much the result of natural aging processes but rather, as a rule, the effect of mental numbing and strains endured well into old age, potentially including ruinous consequences that have already manifested.

*

All the aforementioned physical and mental efforts and strains rarely manifest as acute overexertion. Instead, they only show their effects after some time — pathological effects that subsequently lose any connection with what caused them and produce secondary damage. What turns the gradually emerging symptoms into actual diseases is that people endure the strains and cope with them — until the effects become incurable.

So the chronic illnesses that so stereotypically plague people in today’s society have one essential feature: they are the consequences of stresses that turn into diseases because people continually demand of themselves that they endure them.

2. Modern cause of disease: Class society

Stresses, coping strategies and especially the resulting illnesses always appear in the form of — more or less hard — individual fates. But their general nature, their not-at-all individual or isolated necessity, is common knowledge. Both patients and not-yet-patients concerned about their health are just as aware of this as the doctors who help people stick it out. In any case, it is no open question why the inhabitants of the civilized world always suffer and die so unimaginatively from the same ailments.

Cause of disease: Wage labor

A doctor can expect to see the victims — at the latest when they are pensioners — of a kind of work that requires constant, extremely one-sided exertion and ruins people’s nerves, muscles, joints, etc. Patients can of course readily attribute their ailments to specific pressures at work (unless they take them so for granted as part of life that they forget them) that seem to be hitting them by chance. However, the uniform results are anything but a random accumulation of coincidences.

Thus, modern industry’s great achievement of overcoming Fordism has not so much rendered the need for heavy physical labor obsolete as modified it. Today, one-sided, strenuous assembly tasks, running and fetching tasks, and the like are subsumed under machine-controlled and programmed work processes more than ever; the performance required of a worker is dictated and intensified by the pace of the machinery:

“The intelligent factory of the future no longer has distinct planning and control levels. A digitally received order is fed directly into production. There, the order is passed on to an autonomous assembly assistant that controls itself digitally. This assembly assistant — a mobile workbench — travels to all the various assembly stations and visually assigns tasks to the workers stationed there… The system optimizes planning and generates a new workflow plan for the hours ahead. This may result in workers frequently changing their workstations, unlike in traditional assembly-line work. This can be done because they can start working at a new station without any familiarization period — the assembly assistant tells them exactly what needs to be done” (Frankfurter Allgemeine Zeitung [a major German newspaper], November 16, 2015).

In many areas of the modern working world, less and less strenuous physical work is required; people sit around and move little. But that doesn't mean the work is easy. Working people in any case do not develop ailments from a lack of exertion, but from the interplay of excessively low demands and excessively high one-sided demands on their bodies, which are taxed as intensively as possible at highly efficient, profitable workplaces. For example, some work requires hours of mouse clicking while staring intently at a screen, inevitably leading to all the unpleasant consequences such as neck tension, back pain, tendonitis, and vision problems.

People often only notice the exhaustion that accumulates due to increasing workloads and intense time pressure once the workday is over — if it ever is over. The workweek rarely stops at 40 hours, not just because overtime has become a standard part of daily work life, but because the boundary between work and leisure has become increasingly blurred — particularly with modern working arrangements such as freelance projects and contracts for specific deliverables, which from the outset have no link to actual hours worked, i.e., how long the work takes. Night work and shift work inevitably take a toll on physical and mental well-being.

There is a principle underlying these working conditions under which those who have no other connection to their work than the mere act of performing it atrophy and suffer from stress so stereotypically. The opposing side that sets up the workplace (a precisely defined set of performance requirements) structures the working conditions so that the effort expended is minimal — sometimes approaching zero — relative to the material output. This is done not to relieve the workforce or spare them exertion, but with the aim of extracting from them the maximum possible work that is made productive in this way. The actual expenditure is considered to be not the effort expended by the workers, but the company’s expenditure for them. They are subjected to a ratio, which is to be “optimized,” between wages and performance, in the double form of maximum productivity (a lot per unit of time) and maximum effort (as long and intensive as possible). This calculation of input versus output is the governing principle behind all forms of work organization in companies that ruin the workforce in such a uniform way over time. It is also the basic calculation that quite generally dominates working life in a society blessed with modern diseases of civilization. In industrial production, the economic term for it is “labor cost per unit.” Those in charge insist every day that reducing this cost — mainly by increasing performance and its output — is crucial to the nation’s strength as a business location. It is definitely crucial to the business success of those who pay workers, use them as a means of production, and therefore want to see not merely work, but work per paid unit of time, i.e., performance. In a modern market economy, everything is subordinate to business — and thus to those who conduct it — and this interest in the nation’s jobs has taken the form of an economic/technological imperative to deliver the required performance. So employing people necessarily means wearing them out, so wage labor has to be detrimental to the health of those who perform it.

Health-hazardous working conditions that directly damage workers’ bodies — such as heat, dust, chemicals, noise — are factored into collective bargaining agreements as a result of cost calculations. Enduring this kind of stress to an above-average extent brings a little extra money: a trade-off between health and wages, which requires workers to be quite ruthless towards themselves. Protective regulations and safety gear do not eliminate the health risks of the work process, but often enough mean coping with the risks in a way that makes it harder to deliver the required performance. This is an additional burden that many avoid. Then, when “something happens,” the specialists for occupational health and accident injuries blame, firstly, the workers for their well-known “recklessness” and, secondly, the company only for its lack of enforcement.

Cause of disease: Profitability of the nation as a business location

The instrumental way wage workers treat their bodies is based on a calculation by the other side that pays off. Business owners classify all the health-hazardous consequences of their production as external effects that do not concern them and that, above all, provide no grounds for objecting to their primary interest in profitability. They regard this as part of their bourgeois freedom of action. And this view of theirs is corroborated by the modern welfare state — so thoroughly, in fact, that it subsequently also itself has to make sure that the resulting health damage seems to be a side effect that is truly unavoidable from the standpoint of the primary economic objective. The criteria are necessarily always a matter of dispute.

• With regard to the world of work, the welfare state sets up occupational health and safety regulations, factory inspections, and the like, thereby asserting the position that the average level of harm must be tolerable on the average. Its aim is to mitigate harmful working conditions in such a way that their damaging effects can be viewed in any individual case as a mere possibility: as a health risk that is under public oversight. Whether this suffices is determined by the dispute between the interest groups, all of which must of course be committed to the same socio-political principle.
• Where the employment relationship ends and “the environment” begins, state authority steps in to limit health damage resulting from the productive use of property. It does so through an extensive catalog of environmental protection regulations — listed in Germany since 1974 in the Federal Immission Control Act, which has been repeatedly expanded since then, as well as the Waste Disposal Act and various other individual regulations. These set the permissible limits for using breathing air, water, and soil as a dumping ground initially free of charge, and then, above the limits, for a fee. Logically, this is in the interests of business activities flourishing on every front, since it is the rights and obligations of business that are at issue here. Business owners remain consistent: it is always worth it to compare whether it is cheaper to obey the laws or to violate them. Furthermore, the state paves the way for its industry to export “risks.” Particularly hazardous jobs and toxic-waste disposal are outsourced to the Third World, thereby exporting causes of disease that the “developed” state deems its own people and territory too valuable to be subjected to.
• What applies to the off-site “side effects” of the production process applies equally to the manufactured products. They must be suitable as commercial goods; that is the primary objective of production for the market and the overriding imperative that the state brings into force by staging a competition between owners of productive capital. It is irrelevant if the products are wholesome, unless they are high-priced luxury goods. Consequently, one can expect to find allergens and carcinogens in food and consumer products such as toys, textiles, cosmetics, and furniture, as well as antibiotics (including multi-resistant pathogens) in meat, and similar delights. The state is therefore compelled to impose certain restrictions on entrepreneurial freedom. But it again acts according to the system-compliant principle that average consumers must be able to tolerate certain additives and accompanying effects unless they stubbornly buy the same thing every time. Such prohibitions are only as effective as their enforcement is rigorous and the threatened penalty is severe. Fines and many bribes are therefore often paid with little concern, so that nothing is prevented. On the contrary, state bans spur inventive manufacturers to replace the prohibited substance with something harder to detect. This perpetual circus surrounding the revolting and the toxic is the necessary achievement of a system in which the state makes a guiding principle out of business interests, for which nothing matters but their own success, and then sets about managing the consequences that inevitably follow.

Medical professionals are thus presented in their offices and hospitals with the results of an everyday, large-scale biological experiment. The experimental setup — class-neutral, but with “exposure conditions” specific to occupation, place of residence, and income — poses the question: up to what limit is the human species on average immune to toxins and genetically modified organisms and capable of functioning as a waste processor? And lo and behold: the species responds with cardiovascular and pulmonary disease, cancer, and allergies, but is overall — not least thanks to advanced medicine — tougher than most other flora and fauna.^[3]

Cause of disease: Competition

Gone are the days when the stress symptoms now known as “burnout” were popularly referred to as “managerial syndrome.” While it was not true even in the last century that such ailments primarily afflicted society’s decision-makers, in the twenty-first century they are widely recognized as a common disease affecting all strata of the population. It is hardly surprising that the men and women at the economic helm suffer from stress that is detrimental to their health. After all, while capitalism may make life easy for its leading functionaries in some respects, it turns their existence into a ceaseless competitive struggle both for their own careers within the company and for the company’s business success. At least they can expect to get a handsome reward for enduring the troubles of competing.

In contrast, the competitive efforts of the business-world rank and file look quite paltry and in any case very ineffective. For these people are primarily subjected to comparison. They earn their living by being useful at workplaces that capitalist companies set up, equip and also — if not profitable — abolish, entirely according to their own calculations. Those ‘in dependent employment’ compete with their peers to be used. Their prospects in life depend on making themselves useful to those who ‘have jobs to offer’ and — if they manage to get such a job — proving how useful they are to the company. None of the criteria determining whether they will be used and thus be able to earn a living are under their control: not the constantly changing requirements of the job, not the number of working hours the business situation demands, not the intricacies of the collective bargaining system with its regular regrading of employees; let alone the company’s decisions about which departments are slated for downsizing and which need to be eliminated because they are not profitable… No wonder that job insecurity counts as one of the main sources of stress for those ‘in dependent employment,’ and that people get worn down in their working lives until they can no longer function and an expert doctor diagnoses them with ‘vegetative exhaustion syndrome’ or ‘burnout.’

So such employees, as a dependent variable subject to comparison with no control over the criteria, take their destiny into their own hands. They become proactive, trying not just to meet workplace performance targets but to exceed them, making knowledgeable comparisons with their peers themselves. If all their efforts fail, the fault lies with colleagues who manage to snag the better positions at other people’s expense, meaning at one’s own. The company is only to blame for not giving its employees the recognition that their abilities and commitment deserve. No one complains about the simple fact that capitalist companies of course have a use only for employees who are committed and willing to perform but who are completely replaceable, and these it only needs as long as it is profitable to employ them. Thus, there is a collision between the similar efforts of all those involved to settle into ‘their’ company and ‘their’ workplace as though this were a good place for exercising their own individuality; to identify with the circumstances in which they spend the greater part of their lives — and thereby ultimately also to be successful at work. The competitive battles that are waged here unfold in forms that have little or nothing to do with the criteria a modern company considers in its personnel planning, but are very well suited for making working life real hell and the starting point for psychovegetative disorders. Meanness between colleagues is so commonplace in everyday capitalist competition that it has now — according to World Health Organization criteria — practically attained the status of a medical diagnosis, under the name of ‘harassment.’ And the final irony is that modern companies have in-house ‘harassment officers’ whose job is to make sure the psycho-moral fights between competing employees do not interfere too much with their cooperation in the interests of the company — demonstrating once and for all that the decisive criteria for business success have nothing to do with what the dependent variables imagine, those who are supposed to exert themselves for that business success and are also struggling to maintain their belief that this is exactly where their own personal chance in life lies.

Alongside the system-inherent stress caused by the changing demands of a never really secure job, it is this belief, so consistent with the system and so misguided, that makes for the ‘psycho’ component starting off most of the psychological stress syndromes and psychosomatic disorders. Some employees only get doubts about this belief when they are mustered out. Then, jobless or retired, they mourn the loss of their home at the company, develop depression, and have no idea how much this makes them strictly an artifact of capitalist competition among wage workers.

This shift in perspective — from an object being compared to a subject whose will and particular ability to perform are what matter — also opens up a whole separate world, outside working life, of striving to assert oneself. People start scrutinizing themselves to see if they have what it takes for a successful life or instead are standing in their own way. There is almost always room for doubt. Real and imagined failures in their private or working lives become evidence of being personally unfit for success, and navel-gazing becomes a constant occupation. No wonder that this perspective ultimately produces sweeping and devastating judgments of the most abstract kind, which people then carry out on themselves — and once again there is plenty of material for explanatory articles in TV magazines on the ‘modern plague of depression.’

Cause of disease: Leisure

Modern people supposedly get most of their ailments quite independently of their working lives, through the fun they have in their private lives. If people really were using their health for the purpose of pleasure, then at least they would be choosing the reason for sacrificing their health themselves. If they considered it worthwhile, then at least this part of their physical deterioration would be worth it for them, and not just for those making use of them.

But that is not how most people spend their leisure time. The first thing to do after work is take care of a number of basic necessities. Medically speaking, they should really rest for quite a while and do enough compensatory activity to give their stressed organs a chance to recover. But by the time the body’s self-healing powers did their work, the time would be up, without any real enjoyment of life happening. The demands of recuperation conflict with one’s freedom to shape life according to one’s preferences.

One problem is that those who have to meet the demands of a profitable workplace actually have some trouble ‘unwinding’ — even after the chores of everyday life have been taken care of and a busy working day is over. For it is not only a matter of gaining some physical and temporal distance from work, one also needs some mental distance, so that it often becomes an effort of its own to unwind. On the one hand, unwinding is merely the abstract negative counterpart to work but, on the other, it is the prerequisite for any kind of recovery from it. People all develop their own more or less effective strategies for ‘coming down’ from the stresses of everyday life. The nation’s annual addiction report offers some specifics: some reach for alcohol, others for tranquilizers, perhaps supplemented by ‘uppers’ to counteract the effects of the ‘downers’ the following morning. The pleasures by way of food and drink that are left, the ones without such potential for addiction, are not much healthier. For eating and drinking means consuming what the food industry makes available — and what people can afford. The modern working class therefore no longer suffers from hunger; it suffers from obesity. So people should get more physical activity; the experts are always recommending exercise as a counterbalance to work. Except that, under normal circumstances, squeezing the necessary amount of ‘exercise’ out of everyday life is an effort in itself. Also, experts warn not to overdo it. Otherwise you run the risk of ‘exercise addiction,’ possibly even combined with anorexia…

All of this can of course be interpreted quite differently: modern people can be seen to be ruining themselves for the sake of freely chosen pleasures, whether out of sheer laziness and self-indulgence or out of sheer ambition and vanity. That is in any case how things look from the standpoint that people exist first of all to work, and second to attend to the compensatory needs that their work creates.

The effort to make life enjoyable is, moreover, a question of money before any other decisions can be made. For the mass of employees, depending on their family circumstances, that is a very tight constraint because money first has to go toward what needs dictate. Most of these people therefore spend their free time trying to create a little financial breathing room, which once again means work rather than recreation. Either they take on a second job or other side job, as has become increasingly fashionable in recent years, or they work on their own homes so as to save rent and perhaps have a freer life one day — if they ever get that far. Thus people grapple with the contradiction inherent in their source of income in a way that falls entirely within their private lives.

Meanwhile, family life is carried on under a whole host of compensatory demands — demands it, logically enough, cannot possibly fulfill. Missed opportunities in life do not turn into opportunities by being shared with one’s partner and children. This is why family togetherness so predictably becomes an arena, and also a starting point, for further psychovegetative syndromes. It is no accident that the greatest stabilizing factor of our competitive society appears as an additional ‘stress factor.’ GPs and psychiatrists view the consequences.

The great freedom that comes after a full working life with its physical and mental after-effects is, for most people, anything but pure fun. Reports of the ‘problem of addiction disorders in old age’ are in any case on the rise — whether involving the ‘legal drug’ alcohol or sleeping pills and tranquilizers that the older, discarded members of our performance-oriented society apparently need for their peace of mind. The prescription figures for such medications are impressive; there is no clear dividing line between ‘sleeping-pill abuse’ and ‘medication dependence,’ on the one hand, and the likewise impressive increase in diagnosed ‘senile dementia,’ on the other.

In capitalism, the realm of freedom begins only where money plays no role. The main role is then played by higher-order career anxieties combined with imagined and real obligations to maintain one’s social standing in private life. The corresponding ‘stress symptoms’ confirm the popular belief that ‘money doesn’t buy happiness.’ Moralists like to see this as balancing the scales.

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The modern ‘plagues’ are consequences of modern competitive society, and they even offer a fairly penetrating insight into the economic substance and determining basis of the competitive ‘behavior’ that generally prevails. Both the shared and the particular conditions of existence for the different social characters of this society, their chances in life in general and in the literal medical sense, are shaped above all by the inescapable imperative to earn money as a function of the growth of capital — the all-decisive condition for making a living, that is, the truly underlying purpose. At least, this holds as long as the states in charge allow their peoples’ civilian life to take its usual course and do not alter the demographic age structure by bringing about major acts of violence and the corresponding civilized ways of dying.

This obvious connection can of course be understood in a quite uncritical, world-affirming way. All one needs is a comparison with the causes of illness and death that are not the main ones in the so-called industrialized countries. Such a comparison can be made looking back in time, at bygone eras of murderous childbed fever or, further back still, epidemics of plague. Or it can be made in the present, looking at regions that it is no longer fashionable to call the ‘Third World’ but where the ‘scourge’ of famine and wholly unmodern — ‘classical’ — epidemics has by no means gone out of fashion. It is true that the inhabitants of the ‘developed’ world are also susceptible to norovirus and influenza viruses, especially when the strains of everyday life have run them down in accordance with their age, social class, and locality. But it cannot be denied that they go about their everyday activities under markedly ‘healthier’ conditions than the inhabitants of the many ‘failed’ and ‘failing states’ — namely, in better hygienic conditions and with comprehensive medical care. Yet this salutary difference, firstly, makes all the clearer that it is the specific living conditions in their particular sector of the global market economy, and their ‘developed’ competitive efforts, that are taking a toll on their health. Secondly, the medical progress that has freed some of modern humanity from old afflictions already provides an indication of what this progress not only achieves but what it is good for. People suffer and die for the most part from pressures that are necessarily associated with the profit-generating capacity of the system of capitalist competition at whatever stage it has reached, i.e., pressures that are productive for capital growth. Thirdly and finally, the living conditions in those parts of our ‘One World’ that our ‘First World’ is so favorably distinct from are themselves nothing other than a modern achievement of civilization. It is the same prevailing imperative to earn money and have capital grow that also includes, among its unhealthy to lethal necessities, the following

Cause of disease: ‘Third World’ poverty

Certainly, viruses, bacteria and all sorts of other tiny creatures are unmistakably doing their devastating work in these parts of the world. But in order for them to do so — to cause diseases on a mass scale and ones that so often prove fatal — the little beasts need masses of people living under conditions that the modern world market in conjunction with cooperative local administrations produce wherever it is either not profitable for capital to use people as labor power or only profitable at extremely low wages and under extremely brutal performance demands. The reason why there are so many germs, why they infect people, why infections turn into epidemics, and why so many die from them is not a ‘cruel untouched nature’ teeming with pathogenic parasites in such places; nor is it that the blessings of our civilization have not yet arrived there. The reason lies rather in the kind of civilization that the capitalist mode of production and the world-ordering powers’ regime bestow upon their ‘periphery,’ and that compliant local rulers with a corresponding need for money put into effect and maintain. This civilization furthermore includes not just mass pauperism but also the poisoning of water, air and soil — the basic conditions of life — through oil fields, sulfur mines, chemical waste, and so on, caused by foreign capital that the local rulers welcome and that poisons not only the inhabitants of the regions it exploits. Thus, the ailments afflicting and killing the peoples there are likewise ‘diseases of civilization’: necessary consequences of the rules and constraints that modern imperialism has established worldwide, and of the effects this has already led to over the decades. This is not altered by the fact that many such diseases also occurred at other times under different prevailing conditions: it does not make the ‘civilization’ based on the capitalist world market and a hierarchy of autonomous nation-states any more wholesome that earlier, already highly ‘civilized’ forms of society likewise offered a less-than-gentle treatment of the human material living in them. Those who insist on giving the modern ‘world order’ credit for something can point to the achievement of an aid industry that has more or less freed the inhabitants of the ‘Third World’ from certain dependencies on nature and, through rudimentary medical care, managed to bring about a situation in which the ‘poor countries’ have ever larger masses of people who then die from the consequences of the way of life this order imposes on them.

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So much for what really matters: the causes of the modern ‘plagues’ and their system-specific necessity. For the bourgeois mind and the bourgeois interest in medical research, however, all this is what matters least of all. Criticism is impractical, does not help within the conditions criticized, and certainly does not make anyone society has worn down healthy again.

Medicine doesn’t really do that either. But at least it tends to people: committed to the abundant supply of cases in its blinkered, constructive, and relentless way.